Physicians influence the well-being of many Americans, yet themselves face high risks of mental distress, alcoholism, drug abuse, and stress-related disorders. This research traces physicians from medical school through early career years to examine antecedents of mental health and distress. The major purposes of this project are threefold: (1) to identify the major strains that are encountered in both the professional and personal roles during early years of practice; (2) to examine the impact over time of several variables suggested by the literature to be important risk factors for this population, including role strains, as well as physicians' values; the fit between aspirations and achievement; and the fit between skills acquired during training and professional role demands; and (3) to examine the impact of social support and coping strategies in moderating the relationship between these risk factors and mental distress. Toward these ends, the investigators propose to conduct a rigorously designed longitudinal study. This study would utilize a unique longitudinal database from several cohorts of students enrolled in structurally diverse programs at The University of Michigan. The investigators plan to supplement this database by interviewing a subsample of 200 respondents during their first year of practice and again 18 months later. The research would provide information on antecedents of physician impairment, help identify individuals who are at risk, discover factors associated with mental health, and aid in the design of effective interventions to prevent or alleviate impairment.